2005—2020年南京市肺结核流行特征和时间趋势研究
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E-mail:ruifenmiao@126.com

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南京市医学科技发展资金资助项目(YKK16215)


Epidemiological characteristics and temporal trends of pulmonary tuberculosis in Nanjingfrom 2005 to 2020
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    摘要:

    目的:分析2005—2020年南京市肺结核流行水平及变化趋势,为结核病防控策略的制定和优化提供科学依据。方法:收集2005—2020年“中国疾病预防控制信息系统”子系统“结核病信息管理系统”登记的南京市肺结核病例数据信息,采用 Joinpoint回归模型分析南京市活动性肺结核流行变化趋势,计算年度变化百分比(annual percent change,APC)和平均年度变化百分比(average annual percent change,AAPC)及其95%可信区间(CI)。结果:2005—2020年南京市共报告活动性肺结核患者 51 624例,报告发病率由71.86/10万降至26.08/10万,年均下降6.47%(AAPC=-6.47,95%CI:-9.84 ~-2.97,P < 0.001)。涂阳肺结核报告发病率和所占比例总体均呈下降趋势,年均降幅分别为 8.72%(AAPC=-8.72,95%CI:-14.71~-2.32,P=0.008)和 3.37%(AAPC=-3.37,95%CI:-4.60~-2.12,P < 0.001)。病原学阳性肺结核报告发病率总体变化无统计学意义(AAPC=-6.37, 95%CI:-15.21~3.41,P=0.194),占比则以 2016 年为转折点先降后升。男性和女性肺结核报告发病率均呈下降趋势 (AAPC=-6.80,95%CI:-10.13~-3.35,P < 0.001;AAPC=-6.88,95%CI:-8.54~-5.18,P < 0.001),下降速度差异无统计学意义 (P=0.968),但女性占比呈上升趋势(AAPC=0.99,95%CI:0.31~1.67,P=0.008),而男性占比则逐年下降(AAPC=-0.42,95% CI:-0.73~-0.10,P=0.013)。≥30岁各年龄组报告发病率均呈下降趋势,而0~<15和15~<30岁年龄组报告发病率变化无统计学意义,且15~<30岁年龄组患者占比总体呈上升趋势(AAPC=1.66,95%CI:0.28~3.07,P= 0.019),其余各年龄组患者占比变化差异无统计学意义。中心城区和非中心城区肺结核报告发病率总体均呈下降趋势(AAPC=-8.42,95%CI:-15.60~-0.62,P= 0.035;AAPC=-5.37,95%CI:-9.13~-1.46,P < 0.008),下降速度差异无统计学意义(P=0.478)。中心城区患者占比自2009年之后呈下降趋势(P < 0.001),而非中心城区则呈上升趋势(P < 0.001)。结论:2005—2020年南京市肺结核防控取得显著成效,总体报告发病率下降明显,病原学阳性比例逐年升高,15~<30岁年龄组人群是今后防控工作需重点关注的人群,女性和非中心城区患者占比有上升趋势,应给予一定关注。

    Abstract:

    Objective:This study aims to analyze the epidemiological characteristics and temporal trends of pulmonary tuberculosis (PTB)in Nanjing from 2005 to 2020 and provide scientific evidence for tuberculosis prevention strategy. Methods:Data of registered PTB in Nanjing from 2005 to 2020 was collected through the National Tuberculosis Information Management System. The Joinpoint regression model was used to estimate the annual percent change(APC)as well as the average annual percent change(AAPC)and the 95% CI,respectively. Results:A total of 51 624 PTB were reported with the reported incidence dropped from 71.86/100 000 to 26.08/100 000 and presented overall declining trend,with an average annual decline of 6.47%(AAPC=-6.47,95%CI:-9.84~-2.97, P < 0.001). The reported incidence and the proportion of smear - positive PTB annually decreased by 8.72%(AAPC=- 8.72,95%CI: -14.71~-2.32,P= 0.008)and 3.37%(AAPC=-3.37,95%CI:-4.60~-2.12,P < 0.001),respectively. There was no significant change in reported incidence of bacteriological - positive PTB(AAPC=- 6.37,95% CI:- 15.21~3.41,P=0.194). However,the proportion of bacteriological-positive PTB decreased and then increased with 2016 as the turning point. The reported incidence of PTB in the males and females both presented significant declining trend(AAPC=- 6.80,95% CI:- 10.13~- 3.35,P < 0.001;AAPC=- 6.88,95% CI: -8.54~-5.18,P < 0.001),and there was no significant difference in the decline rate between the males and females(P=0.968). The proportion of the female cases increased(AAPC=0.99,95%CI:0.31~1.67,P=0.008),while the proportion of the male cases decreased (AAPC=-0.42,95%CI:-0.73~-0.10,P=0.013)annually. The reported incidence rate of all age groups of ≥ 30 years old showed a downward trend,while the reported incidence rate changes of groups of 0~< 15 and 15~< 30 years old had no statistical significance. In addition,the proportion of 15~<30 years old age group showed an increasing trend(AAPC=1.66,95%CI:0.28~3.07,P=0.019)while there was no significant change trend of all the other age groups. The PTB reported incidence in the main urban districts and the suburban districtsall showed decreasing trend(AAPC=-8.42,95%CI:-15.60~-0.62,P=0.035;AAPC=-5.37,95%CI:-9.13~-1.46, P < 0.008),and there was no significant difference with respect to the decline rate(P=0.478). However,the proportion of patients in the central urban area has shown a downward trend(P < 0.001)since 2009,while that in the non central urban area has shown an upward trend(P < 0.001). Conclusion:The overall reported incidence of tuberculosis in Nanjing showed a downward trend from 2005 to 2020 and the pathogen positive rate increased annually since 2016. More effort should be paid to the 15~<30 years old age group population,meanwhile the proportion of women and patients in non central urban areas is on the rise,which should be paid attention to.

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苗瑞芬,王荣,李晨,杨晨,许可,张大卫,江燕.2005—2020年南京市肺结核流行特征和时间趋势研究[J].南京医科大学学报(自然科学版),2022,42(11):1605-1613,1620

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